一项比较自动调压与持续气道正压通气对嗳气症状患者影响的随机交叉试验：对依从性和主观症状的影响
A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms.
作者信息
Shirlaw Teresa, Hanssen Kevin, Duce Brett, Hukins Craig
机构信息
Sleep Disorders Centre, Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
出版信息
J Clin Sleep Med. 2017 Jul 15;13(7):881-888. doi: 10.5664/jcsm.6658.
STUDY OBJECTIVES
To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia.
METHODS
This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6-20 cm HO, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm.
RESULTS
The median pressure ( < .001) and 95th centile pressure ( < .001) were reduced with APAP but no differences in compliance ( = .120) and residual AHI were observed. APAP reduced the symptoms of bloating ( = .011), worst episode of bloating ( = .040), flatulence ( = .010), and belching ( = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP.
CONCLUSIONS
APAP therapy reduces the symptoms of aerophagia while not affecting compliance when compared with CPAP therapy.
CLINICAL TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry at https://www.anzctr.org.au, trial number ACTRN12611001250921.
COMMENTARY
A commentary on this article appears in this issue on page 859.
研究目的
评估自动调压气道正压通气（APAP）与持续气道正压通气（CPAP）对有吞气症患者的疗效及耐受性。
方法
这是一项在澳大利亚一家三级医院临床睡眠实验室进行的前瞻性、为期两周的双盲随机交叉试验报告。招募了56名自述因CPAP出现吞气症症状的受试者。56名受试者中有39名使用全面罩。受试者被随机、盲法分配到按推荐治疗压力使用CPAP或使用6 - 20 cm HO的APAP，顺序随机。受试者在每种治疗模式下各接受两周治疗。在每两周治疗期结束时报告治疗使用时长、第95百分位数压力、最大压力、第95百分位数漏气量以及残余呼吸暂停低通气指数（AHI）。在每个为期2周的治疗阶段结束时，还完成了用于测量吞气症症状的嗜睡问卷功能结果、爱泼华嗜睡量表和视觉模拟量表。
结果
APAP可降低中位压力（P <.001）和第95百分位数压力（P <.001），但在依从性（P =.120）和残余AHI方面未观察到差异。与CPAP相比，APAP可减轻腹胀症状（P =.011）、最严重腹胀发作（P =.040）、肠胃胀气（P =.010）和嗳气（P =.001）。CPAP和APAP在爱泼华嗜睡量表或嗜睡问卷功能结果方面无差异。
结论
与CPAP治疗相比，APAP治疗可减轻吞气症症状，同时不影响依从性。
临床试验注册
澳大利亚和新西兰临床试验注册中心，网址为https://www.anzctr.org.au，试验编号ACTRN12611001250921。
评论
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